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A loophole in the Affordable Care Act may be causing expecting and new mothers to incur significant out-of-pocket costs before, during and after giving birth, a new analysis suggests.

In findings published Monday in the journal Health Affairs, researchers noted that, for some American families, average out-of-pocket healthcare spending for maternity care -- including during pregnancy, delivery and three months postpartum -- jumped from $3,069 in 2008 to $4,569 in 2015, a nearly 50 percent increase.

And, while the ACA, also known as Obamacare, requires insurers to provide full coverage for preventive services such as pap smears and mammograms, there are few restrictions on how plans impose co-pays, deductibles and cost-sharing for maternity care.

Approximately half of all women in the U.S. are covered by ACA plans, the authors of the Health Affairs article said.

"Providing robust health insurance coverage to pregnant women has been a policy goal for decades," co-author Michelle Moniz, an obstetrician gynecologist at Michigan Medicine's Von Voigtlander Women's Hospital, told UPI. "Prenatal, delivery, and postpartum services are essential to the health of moms and babies, and should be available to everyone without financial barriers."

Moniz and her colleagues analyzed a national sample of 657,061 women enrolled in 84,178 employer-sponsored health insurance plans who had been hospitalized for childbirth from 2008 to 2015. Their assessment included costs for all healthcare services used before and after delivery that might influence pregnancy outcomes.

In all, 98 percent of women were found to be paying some out-of-pocket costs. Women who had vaginal births covered 21 percent of all expenses in 2015 compared to 13 percent in 2008.

Perhaps not surprisingly, out-of-pocket costs for women undergoing cesarean sections, or C-sections, were even higher. Mean total out-of-pocket spending for these women rose from $3,364 in 2008 to $5,161 in 2015, compared to an increase of $2,910 to $4,314 for women having vaginal births.

Overall, women who had C-sections paid for approximately 15 percent of total costs out-of-pocket in 2015, up from 10 percent in 2008.

According to Moniz, maternity care services are vital to ensuring the best possible outcomes for moms and newborns, and research suggests that out-of-pocket costs for healthcare are often associated with "skipped care." She noted that increasing financial burdens may be placing women at risk for delaying or missing maternity care, which may lead to poor outcomes for women and newborns.

Moniz would like to see lawmakers impose limitations on out-of-pocket costs for maternity care, even among ACA plans with higher deductibles and co-pays.

She said this is a particularly important consideration given that the U.S. is one of the only developed countries with a rising maternal mortality rate, and reducing costs may help make maternal and neonatal health services more accessible and affordable for American families.

"This study identifies an important opportunity to improve maternity coverage for working women to eliminate out of pocket costs," she said. "We hope that these findings prompt state and federal policymakers to pursue legislation that would eliminate or reduce out of pocket costs for maternity care. "
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